Question of the day - DNR's

[Guest guest]

This list is DEAD, so I am going to revive it with a discussion on DNR's.

What constitutes a " valid " DNR?

Enjoy,

Tater

E. Tate, LP

Whitehouse, Texas

What’s stopping you from joining EMSAT? http://www.TexasEMSAT.org

---------------------------------

Yahoo! Mail

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[Guest guest]

Hmm, I have always found that post-it's work well...

But seriously, pt's sig and MD's sig on state of TX OOH DNR is required as

well as what is/is not to be done (CPR, PEG tube, etc.) within the form. If pt

is unable to sign, 2 MD's sigs and/or pt's medical power of attorney's sig.

Of course this is all assuming there is no family member throttling you and

screaming, " NO!! SAVE HIM!!! "

-Lala EMT-B

" E. Tate " wrote:

This list is DEAD, so I am going to revive it with a discussion on DNR's.

What constitutes a " valid " DNR?

Enjoy,

Tater

E. Tate, LP

Whitehouse, Texas

What’s stopping you from joining EMSAT? http://www.TexasEMSAT.org

---------------------------------

Yahoo! Mail

Bring photos to life! New PhotoMail makes sharing a breeze.

[Guest guest]

I have also heard of people wanting to get a DNR tattooed somewhere on their

bodies (signatures and all)... would that be legally acceptable?? Wes, Gene?

-Lala EMT-B

" E. Tate " wrote:

This list is DEAD, so I am going to revive it with a discussion on DNR's.

What constitutes a " valid " DNR?

Enjoy,

Tater

E. Tate, LP

Whitehouse, Texas

What’s stopping you from joining EMSAT? http://www.TexasEMSAT.org

---------------------------------

Yahoo! Mail

Bring photos to life! New PhotoMail makes sharing a breeze.

[Guest guest]

In a message dated 14-Mar-06 00:39:29 Central Standard Time,

texaslp@... writes:

This list is DEAD, so I am going to revive it with a discussion on DNR's.

What constitutes a " valid " DNR?

One: A properly executed (per state law) DNR form or Living Will with

appropriate instructions.

Two: A cooperative family who understand the limitations of care under said

request.

Three: Some way of providing said form to the responding crew AND

appropriate medical control...starting with some sort of bracelet or necklace

on the

patient pointing us in the right direction if there is no family around...

Without the third leg, it's often a problem to find the paperwork in time.

In areas where I have found myself established for a period of time, I've

often been able to confirm, from knowing the patient/family, that there is

legal

paperwork on file, or we may have had said paperwork in a file at the

ED...The 'Vial of Life' program may help there,...improving the odds that there

is

one place to look in the household for vital medical (and DNR) information on

the patient.

S. Krin, DO FAAFP

[Guest guest]

In a message dated 14-Mar-06 08:21:12 Central Standard Time,

texaslp@... writes:

" A properly executed (per state law) DNR form or Living Will with

appropriate instructions. "

In your opinion based on the law (Texas preferred, but any state will work

for our nomads) what must be included in this form for it to constitute a

valid form?

I understand the other parts are necessary also, but for the purposes of

this argument, I am asking about the paper document only.

this will vary by state, but generally includes a signed statement of the

patient's intent NOT to be placed on life support systems (OR that the patient

not be resuscitated if said patient is otherwise in extremitis) if there is

no reasonable chance of recovery, along with witness signatures- often

notarization is also needed.

Sometimes it can be more specific, especially for the living wills...'no

feeding tubes', 'no intubation but medications allowed'...

In the event that the patient is already mentally incapacitated, it is

usually signed by either the patient's previously arranged 'power of attorney'

or

appointed legal guardian (which can be either a permanent position, or you

might remember the 'Guardian ad Litum' of the case in Florida some time

back...where it was a temporary position) and preferably co signed by the

closest

family members available (generally, but not exclusively, current spouse, adult

children, parents, adult grandchildren, and then down the line from there-

about in that order for Louisiana Law.)

S. Krin, DO FAAFP

[Guest guest]

In a message dated 14-Mar-06 08:12:01 Central Standard Time,

texaslp@... writes:

So, this order MUST be on the OOH DNR to be valid?

A family member's verbal objections overrule the patients signed DNR?

Not all states have an 'official' form.

and from past experience, even if great aunt by marriage Edna from Mouse

Drool, Alaska objects (if she is present at the time), then you'd better get a

quick consensus from the family as to what you do...while it would be tough

for a spouse or a relative who is not of the first degree of consanguinity

(parents, children, siblings, grandchildren) to sue, I've seen some Ghod awful

messes when part of the family wants to let the poor old person die, and the

rest of the family can't let go...

ck

S. Krin, DO FAAFP

[Guest guest]

In a message dated 14-Mar-06 08:16:40 Central Standard Time,

texaslp@... writes:

I'm looking for the bare minimum that would be legal as far as you are

concerned.

Imagine rolling up at the “Graveside Manor Nursing Home and Crematorium, Inc.

†for a SOB call. Immediately upon your arrival, the patient codes

(witnessed). The nurse hands you a piece of paper that says “Advanced

Directiveâ€, “

DNR†or some other catchy phrase across the top. (This form is not the fancy

TX OOH DNR form.) What item(s) would be necessary on this for to be

“validâ€

in your opinion?

I want to gauge the feel of the list and then we’ll ask the legal eagles to

weigh in as to what the law actually says.

Chuckle...I've seen the folks at the NH *refuse* to give a DNR paper to the

ambo crews before, claiming that the patient 'woke up' and asked to be helped

(in a patient who had was a contracted, kyphotic wreck of a shell of a

former human being, dependant on tube feedings for a decade, and who had

infected

bed sores of every part of her anatomy in contact with the bed), but I can't

remember any case where the NH honored the DNR where I wasn't directly

involved and instructed the NH NOT to call the ambulance, but that I would be

out

to pronounce the patient before the ambo could get there in any case.

Point is, if there was a valid DNR in the patient's file, why is the NH

calling the ambo in the first place? They should be calling either the primary

doc, the facility's medical director or the coroner/medical examiner to get the

decedent properly pronounced and cleared by the organ donation folks so that

the mortuary folks can take over...

ck

S. Krin, DO FAAFP

[Guest guest]

Are you looking for details or the short answer?

The short answer: A properly executed Out-of-Hospital Do

Nor Resuscitate form or approved identification device.

Maxine

hire-Pattison EMS

---- Original message ----

>Date: Mon, 13 Mar 2006 22:39:02 -0800 (PST)

>

>

>

> What constitutes a " valid " DNR?

>

>

> Enjoy,

> Tater

>

>

>

> E. Tate, LP

>Whitehouse, Texas

>

[Guest guest]

Lala,

So, this order MUST be on the OOH DNR to be valid?

A family member's verbal objections overrule the patients signed DNR?

Tater

Lala wrote:

Hmm, I have always found that post-it's work well...

But seriously, pt's sig and MD's sig on state of TX OOH DNR is required as

well as what is/is not to be done (CPR, PEG tube, etc.) within the form. If pt

is unable to sign, 2 MD's sigs and/or pt's medical power of attorney's sig.

Of course this is all assuming there is no family member throttling you and

screaming, " NO!! SAVE HIM!!! "

-Lala EMT-B

" E. Tate " wrote:

This list is DEAD, so I am going to revive it with a discussion on DNR's.

What constitutes a " valid " DNR?

Enjoy,

Tater

E. Tate, LP

Whitehouse, Texas

What’s stopping you from joining EMSAT? http://www.TexasEMSAT.org

---------------------------------

Yahoo! Mail

Bring photos to life! New PhotoMail makes sharing a breeze.

[Guest guest]

I'm looking for the bare minimum that would be legal as far as you are

concerned.

Imagine rolling up at the “Graveside Manor Nursing Home and Crematorium, Inc.”

for a SOB call. Immediately upon your arrival, the patient codes (witnessed).

The nurse hands you a piece of paper that says “Advanced Directive”, “DNR” or

some other catchy phrase across the top. (This form is not the fancy TX OOH DNR

form.) What item(s) would be necessary on this for to be “valid” in your

opinion?

I want to gauge the feel of the list and then we’ll ask the legal eagles to

weigh in as to what the law actually says.

Tater

hire-Pattison EMS wrote: Are you looking for

details or the short answer?

The short answer: A properly executed Out-of-Hospital Do

Nor Resuscitate form or approved identification device.

Maxine

hire-Pattison EMS

---- Original message ----

>Date: Mon, 13 Mar 2006 22:39:02 -0800 (PST)

>

>

>

> What constitutes a " valid " DNR?

>

>

> Enjoy,

> Tater

>

>

>

> E. Tate, LP

>Whitehouse, Texas

>

[Guest guest]

" A properly executed (per state law) DNR form or Living Will with appropriate

instructions. "

In your opinion based on the law (Texas preferred, but any state will work for

our nomads) what must be included in this form for it to constitute a valid

form?

I understand the other parts are necessary also, but for the purposes of this

argument, I am asking about the paper document only.

Tater

krin135@... wrote:

In a message dated 14-Mar-06 00:39:29 Central Standard Time,

texaslp@... writes:

This list is DEAD, so I am going to revive it with a discussion on DNR's.

What constitutes a " valid " DNR?

One: A properly executed (per state law) DNR form or Living Will with

appropriate instructions.

Two: A cooperative family who understand the limitations of care under said

request.

Three: Some way of providing said form to the responding crew AND

appropriate medical control...starting with some sort of bracelet or necklace

on the

patient pointing us in the right direction if there is no family around...

Without the third leg, it's often a problem to find the paperwork in time.

In areas where I have found myself established for a period of time, I've

often been able to confirm, from knowing the patient/family, that there is

legal

paperwork on file, or we may have had said paperwork in a file at the

ED...The 'Vial of Life' program may help there,...improving the odds that there

is

one place to look in the household for vital medical (and DNR) information on

the patient.

S. Krin, DO FAAFP

[Guest guest]

Hey y'all,

I've read the questions on the list about DNR and need to respond. I

am the person in charge of the program for the state. There's been

some good things on the list in the last couple of days, and several

statements that are not correct.

I'll try to address everything that has been mentioned, but I might

miss some. I know you will have questions and I will try to answer

the ones I can; others I will have to get our attorney to weigh in

on. I know these are tough issues but we want everyone to get a good

understanding. Having said that, we get questions at least once a

month that we've never thought of!

A valid form is one in which it appears all the signatures are there,

including patient (or surrogate), witnesses and physicians (A, B and

C); or two physicians (D). Everyone must sign again at the bottom,

according to statute.

There is no choosing which procedures to have on a DNR; it's all or

nothing. Other advance directive may allow that, but not the Texas

OOH DNR.

Emergency medical personnel in Texas may honor only a Texas Out-of-

Hospital DNR form or device (bracelet or necklace) (HSC 166.102 ().

Other health care professionals can honor other advance directives,

including notations in charts. (History: It is worded like this so

EMS would not have to `practice law' in the two minutes they have at

the bedside by trying to interpret other directives.)

A tattoo is not a form or a device. It might be able to be argued in

court, but unless the tattooist got proof of the form before the

tattoo was done, it would be a tough argument to make. Device

manufacturers are supposed to have proof of the form before device is

sold.

Can family's objections be honored? Depends on who signed the form.

If a patient and doctor signed the form, then only they can revoke.

Whoever signed the form are the ones who can revoke. That is listed

on the back of the form under Revocation.

And two other things that weren't mentioned: The OOH DNR is

automatically revoked if patient is known to be pregnant or in the

case of unnatural or suspicious circumstances; and a minor must have

a terminal or irreversible condition to have a DNR executed.

Our website: http://www.tdh.state.tx.us/hcqs/ems/dnrhome.htm

Thanks,

>

>

> In a message dated 14-Mar-06 08:16:40 Central Standard Time,

> texaslp@... writes:

>

> I'm looking for the bare minimum that would be legal as far as you

are

> concerned.

>

> Imagine rolling up at the “Graveside Manor Nursing Home and

Crematorium, Inc.

> †for a SOB call. Immediately upon your arrival, the patient

codes

> (witnessed). The nurse hands you a piece of paper that says

“Advanced Directiveâ€, “

> DNR†or some other catchy phrase across the top. (This form is

not the fancy

> TX OOH DNR form.) What item(s) would be necessary on this for to

be “validâ€

> in your opinion?

>

> I want to gauge the feel of the list and then we’ll ask the

legal eagles to

> weigh in as to what the law actually says.

>

>

>

>

> Chuckle...I've seen the folks at the NH *refuse* to give a DNR

paper to the

> ambo crews before, claiming that the patient 'woke up' and asked

to be helped

> (in a patient who had was a contracted, kyphotic wreck of a shell

of a

> former human being, dependant on tube feedings for a decade, and

who had infected

> bed sores of every part of her anatomy in contact with the bed),

but I can't

> remember any case where the NH honored the DNR where I wasn't

directly

> involved and instructed the NH NOT to call the ambulance, but that

I would be out

> to pronounce the patient before the ambo could get there in any

case.

>

> Point is, if there was a valid DNR in the patient's file, why is

the NH

> calling the ambo in the first place? They should be calling either

the primary

> doc, the facility's medical director or the coroner/medical

examiner to get the

> decedent properly pronounced and cleared by the organ donation

folks so that

> the mortuary folks can take over...

>

> ck

>

> S. Krin, DO FAAFP

>

>

>

>

[Guest guest]

Re: Question of the day - DNR's

(clipped)

Emergency medical personnel in Texas may honor only a Texas Out-of-

Hospital DNR form or device (bracelet or necklace) (HSC 166.102 ().

Other health care professionals can honor other advance directives,

including notations in charts. (History: It is worded like this so

EMS would not have to `practice law' in the two minutes they have at

the bedside by trying to interpret other directives.)

(clipped)

---------- End of message -----------

Appreciate your info! I have a question that those in the transfer

ambulance services in this area run into frequently, and get a few differing

answers depending on who I talk to.

Scenerio: An elderly patient is being transferred from the hospital floor

back to the nursing home by ambulance. The patient did not have an OOH-DNR

in effect prior to being admitted to the hospital. However, days later her

medical condition has declined to where not much else can be done for her.

On transport day, while searching through her medical records the EMT finds

a circled, signed, and dated physician's order stating, " DNR - Do Not

Resuscitate " . There is still no OOH-DNR in her records, and the nurse

confirms that these orders are the only source of information about her code

status. EMT makes a copy of this order and maintains this DNR status based

on it.

Back when I was employed by a particular transfer service, I was informed

(correctly or incorrectly) that this physician's order would be acceptable

for transport until the patient was placed in her bed and care transferred

at her destination. I could not find supporting information on the TDSHS

site about this. Thoughts?

Thanks!

Kim

[Guest guest]

Kim,

At this point, the statute is clear: emergency medical personnel may

honor *only* (emphasis added) a Texas Out-of-Hospital form or

device...

So the answer is no, you could not honor anything not on an official

Texas OOH DNR form. Thanks,

>

> Re: Question of the day - DNR's

>

> (clipped)

>

> Emergency medical personnel in Texas may honor only a Texas Out-of-

> Hospital DNR form or device (bracelet or necklace) (HSC 166.102

().

> Other health care professionals can honor other advance directives,

> including notations in charts. (History: It is worded like this so

> EMS would not have to `practice law' in the two minutes they have at

> the bedside by trying to interpret other directives.)

>

> (clipped)

>

> ---------- End of message -----------

>

>

> Appreciate your info! I have a question that those in the transfer

> ambulance services in this area run into frequently, and get a few

differing

> answers depending on who I talk to.

>

> Scenerio: An elderly patient is being transferred from the hospital

floor

> back to the nursing home by ambulance. The patient did not have an

OOH-DNR

> in effect prior to being admitted to the hospital. However, days

later her

> medical condition has declined to where not much else can be done

for her.

> On transport day, while searching through her medical records the

EMT finds

> a circled, signed, and dated physician's order stating, " DNR - Do

Not

> Resuscitate " . There is still no OOH-DNR in her records, and the

nurse

> confirms that these orders are the only source of information about

her code

> status. EMT makes a copy of this order and maintains this DNR

status based

> on it.

>

> Back when I was employed by a particular transfer service, I was

informed

> (correctly or incorrectly) that this physician's order would be

acceptable

> for transport until the patient was placed in her bed and care

transferred

> at her destination. I could not find supporting information on the

TDSHS

> site about this. Thoughts?

>

> Thanks!

>

> Kim

>

[Guest guest]

Except out of state, which does not present on a Texas Out of Hospital form

or device…

Jack Pitcock

Texas Administrative Code

Next

<http://info.sos.state.tx.us/pls/pub/readtac$ext.TacPage?sl=T & app=9 & p_dir=N &

p_rloc=113847 & p_tloc= & p_ploc=1 & pg=2 & p_tac= & ti=25 & pt=1 & ch=157 & rl=25> Rule>>

<http://info.sos.state.tx.us/pls/pub/readtac$ext.ViewTAC?tac_view=2 & ti=25>

TITLE 25

HEALTH SERVICES

<http://info.sos.state.tx.us/pls/pub/readtac$ext.ViewTAC?tac_view=3 & ti=25 & pt

=1> PART 1

DEPARTMENT OF STATE HEALTH SERVICES

<http://info.sos.state.tx.us/pls/pub/readtac$ext.ViewTAC?tac_view=4 & ti=25 & pt

=1 & ch=157> CHAPTER 157

EMERGENCY MEDICAL CARE

<http://info.sos.state.tx.us/pls/pub/readtac$ext.ViewTAC?tac_view=5 & ti=25 & pt

=1 & ch=157 & sch=B & rl=Y> SUBCHAPTER B

EMERGENCY MEDICAL SERVICES PROVIDER LICENSES

RULE §157.25

Out-of-Hospital Do Not Resuscitate (DNR) Order

<clipped stuff>

e) Out-of-state DNR Orders. Personnel may accept an out-of-hospital DNR

order or device that has been executed in any other state, if there is no

reason to question the authenticity of the order or device.

_____

From: texasems-l [mailto:texasems-l ] On

Behalf Of kaydeeharrell

Sent: Tuesday, March 14, 2006 1:15 PM

To: texasems-l

Subject: Re: Question of the day - DNR's

Kim,

At this point, the statute is clear: emergency medical personnel may

honor *only* (emphasis added) a Texas Out-of-Hospital form or

device...

So the answer is no, you could not honor anything not on an official

Texas OOH DNR form. Thanks,

>

> Re: Question of the day - DNR's

>

> (clipped)

>

> Emergency medical personnel in Texas may honor only a Texas Out-of-

> Hospital DNR form or device (bracelet or necklace) (HSC 166.102

().

> Other health care professionals can honor other advance directives,

> including notations in charts. (History: It is worded like this so

> EMS would not have to `practice law' in the two minutes they have at

> the bedside by trying to interpret other directives.)

>

> (clipped)

>

> ---------- End of message -----------

>

>

> Appreciate your info! I have a question that those in the transfer

> ambulance services in this area run into frequently, and get a few

differing

> answers depending on who I talk to.

>

> Scenerio: An elderly patient is being transferred from the hospital

floor

> back to the nursing home by ambulance. The patient did not have an

OOH-DNR

> in effect prior to being admitted to the hospital. However, days

later her

> medical condition has declined to where not much else can be done

for her.

> On transport day, while searching through her medical records the

EMT finds

> a circled, signed, and dated physician's order stating, " DNR - Do

Not

> Resuscitate " . There is still no OOH-DNR in her records, and the

nurse

> confirms that these orders are the only source of information about

her code

> status. EMT makes a copy of this order and maintains this DNR

status based

> on it.

>

> Back when I was employed by a particular transfer service, I was

informed

> (correctly or incorrectly) that this physician's order would be

acceptable

> for transport until the patient was placed in her bed and care

transferred

> at her destination. I could not find supporting information on the

TDSHS

> site about this. Thoughts?

>

> Thanks!

>

> Kim

>

[Guest guest]

In a message dated 14-Mar-06 18:22:34 Central Standard Time,

kirkmahon@... writes:

Why call EMS if DNR?

Because some patients just decline ACLS type stuff but still want regular

medical care. So if they have a change in mental status and are found to

have a BP of 80, it is appropriate to call EMS so they may get iv fluids and

abx for their urosepsis (as an example.) That is unless the NH or PMD can

provide that care on site.

Kirk D. Mahon, MD, ABEM

Agreed...I was attempting to use reduction to the absurd to show how some of

the Nursing homes of my experience were using the EMS system improperly...

too often in my career, I have seen DNRs violated by NH's to shift the

burden of the aftercare to the ED.

ck

S. Krin, DO FAAFP

[Guest guest]

In a message dated 14-Mar-06 18:22:34 Central Standard Time,

kirkmahon@... writes:

Why call EMS if DNR?

Because some patients just decline ACLS type stuff but still want regular

medical care. So if they have a change in mental status and are found to

have a BP of 80, it is appropriate to call EMS so they may get iv fluids and

abx for their urosepsis (as an example.) That is unless the NH or PMD can

provide that care on site.

Kirk D. Mahon, MD, ABEM

S. Krin, DO FAAFP

[Guest guest]

Excellent catch, Jack. You're right: it is specifically spelled out

in EMS Rule 157.25

Out-of-state DNR Orders. Personnel may accept an out-of-hospital DNR

order or device that has been executed in any other state, if there

is no reason to question the authenticity of the order or device.

Thanks, Jack!

> >

> > Re: Question of the day - DNR's

> >

> > (clipped)

> >

> > Emergency medical personnel in Texas may honor only a Texas Out-

of-

> > Hospital DNR form or device (bracelet or necklace) (HSC 166.102

> ().

> > Other health care professionals can honor other advance

directives,

> > including notations in charts. (History: It is worded like this so

> > EMS would not have to `practice law' in the two minutes they have

at

> > the bedside by trying to interpret other directives.)

> >

> > (clipped)

> >

> > ---------- End of message -----------

> >

> >

> > Appreciate your info! I have a question that those in the

transfer

> > ambulance services in this area run into frequently, and get a

few

> differing

> > answers depending on who I talk to.

> >

> > Scenerio: An elderly patient is being transferred from the

hospital

> floor

> > back to the nursing home by ambulance. The patient did not have

an

> OOH-DNR

> > in effect prior to being admitted to the hospital. However, days

> later her

> > medical condition has declined to where not much else can be done

> for her.

> > On transport day, while searching through her medical records the

> EMT finds

> > a circled, signed, and dated physician's order stating, " DNR - Do

> Not

> > Resuscitate " . There is still no OOH-DNR in her records, and the

> nurse

> > confirms that these orders are the only source of information

about

> her code

> > status. EMT makes a copy of this order and maintains this DNR

> status based

> > on it.

> >

> > Back when I was employed by a particular transfer service, I was

> informed

> > (correctly or incorrectly) that this physician's order would be

> acceptable

> > for transport until the patient was placed in her bed and care

> transferred

> > at her destination. I could not find supporting information on

the

> TDSHS

> > site about this. Thoughts?

> >

> > Thanks!

> >

> > Kim

> >

>

>

>

>

>

>

>

>

[Guest guest]

,

Thank you once again for your enlightenment!

Tater

kaydeeharrell wrote:

Kim,

At this point, the statute is clear: emergency medical personnel may

honor *only* (emphasis added) a Texas Out-of-Hospital form or

device...

So the answer is no, you could not honor anything not on an official

Texas OOH DNR form. Thanks,

>

> Re: Question of the day - DNR's

>

> (clipped)

>

> Emergency medical personnel in Texas may honor only a Texas Out-of-

> Hospital DNR form or device (bracelet or necklace) (HSC 166.102

().

> Other health care professionals can honor other advance directives,

> including notations in charts. (History: It is worded like this so

> EMS would not have to `practice law' in the two minutes they have at

> the bedside by trying to interpret other directives.)

>

> (clipped)

>

> ---------- End of message -----------

>

>

> Appreciate your info! I have a question that those in the transfer

> ambulance services in this area run into frequently, and get a few

differing

> answers depending on who I talk to.

>

> Scenerio: An elderly patient is being transferred from the hospital

floor

> back to the nursing home by ambulance. The patient did not have an

OOH-DNR

> in effect prior to being admitted to the hospital. However, days

later her

> medical condition has declined to where not much else can be done

for her.

> On transport day, while searching through her medical records the

EMT finds

> a circled, signed, and dated physician's order stating, " DNR - Do

Not

> Resuscitate " . There is still no OOH-DNR in her records, and the

nurse

> confirms that these orders are the only source of information about

her code

> status. EMT makes a copy of this order and maintains this DNR

status based

> on it.

>

> Back when I was employed by a particular transfer service, I was

informed

> (correctly or incorrectly) that this physician's order would be

acceptable

> for transport until the patient was placed in her bed and care

transferred

> at her destination. I could not find supporting information on the

TDSHS

> site about this. Thoughts?

>

> Thanks!

>

> Kim

>

[Guest guest]

Why call EMS if DNR?

Because some patients just decline ACLS type stuff but still want regular

medical care. So if they have a change in mental status and are found to

have a BP of 80, it is appropriate to call EMS so they may get iv fluids and

abx for their urosepsis (as an example.) That is unless the NH or PMD can

provide that care on site.

Kirk D. Mahon, MD, ABEM

6106 Keller Springs Rd

Dallas, TX 75248

[Guest guest]

,

What type of " education " program is in place for nursing homes, doctors, etc?

Since many of us on this list were unaware of the requirement for this form, I

am sure most nursing homes and doctors have no clue about it either. I knew the

form existed, but did not know it was the one and only form we were supposed to

recognize. I probably read that at one time or another, and forgot and since I

am employed with a Fire Department that only 1st responds, we don’t run into

this situation very often.

I think EMS could do some really positive PR by informing the facilities that

use these forms about their necessity. We could couple this with education

about not calling EMS for a code involving a DNR patient.

Wes, Gene, , & ,

Is there a way to pass this information along to attorneys so they could

include it when consulting with families about living wills, etc?

Just my delirious late night thoughts,

Tater

kaydeeharrell wrote:

Excellent catch, Jack. You're right: it is specifically spelled out

in EMS Rule 157.25

Out-of-state DNR Orders. Personnel may accept an out-of-hospital DNR

order or device that has been executed in any other state, if there

is no reason to question the authenticity of the order or device.

Thanks, Jack!

> >

> > Re: Question of the day - DNR's

> >

> > (clipped)

> >

> > Emergency medical personnel in Texas may honor only a Texas Out-

of-

> > Hospital DNR form or device (bracelet or necklace) (HSC 166.102

> ().

> > Other health care professionals can honor other advance

directives,

> > including notations in charts. (History: It is worded like this so

> > EMS would not have to `practice law' in the two minutes they have

at

> > the bedside by trying to interpret other directives.)

> >

> > (clipped)

> >

> > ---------- End of message -----------

> >

> >

> > Appreciate your info! I have a question that those in the

transfer

> > ambulance services in this area run into frequently, and get a

few

> differing

> > answers depending on who I talk to.

> >

> > Scenerio: An elderly patient is being transferred from the

hospital

> floor

> > back to the nursing home by ambulance. The patient did not have

an

> OOH-DNR

> > in effect prior to being admitted to the hospital. However, days

> later her

> > medical condition has declined to where not much else can be done

> for her.

> > On transport day, while searching through her medical records the

> EMT finds

> > a circled, signed, and dated physician's order stating, " DNR - Do

> Not

> > Resuscitate " . There is still no OOH-DNR in her records, and the

> nurse

> > confirms that these orders are the only source of information

about

> her code

> > status. EMT makes a copy of this order and maintains this DNR

> status based

> > on it.

> >

> > Back when I was employed by a particular transfer service, I was

> informed

> > (correctly or incorrectly) that this physician's order would be

> acceptable

> > for transport until the patient was placed in her bed and care

> transferred

> > at her destination. I could not find supporting information on

the

> TDSHS

> > site about this. Thoughts?

> >

> > Thanks!

> >

> > Kim

> >

>

>

>

>

>

>

>

>

[Guest guest]

My apologies for not answering sooner. I have been trying to keep up

with the list but missed this one.

Our only avenue of education is Texas EMS Magazine and our website.

We do run fairly regular articles about DNR in the magazine, and we

hope that medics (our educators) will take the information out to the

nursing homes in their areas. We put every bit of information we can

think of on our website. The website comes up as the first or second

link on a Google search for " Texas DNR. "

As for nursing homes in particular, there is a bit of a disconnect as

nursing homes are regulated (and doctors as well) by another state

agency. I will check into the possibility of piggy-backing onto

mailouts that go out from those agencies.

For now, I am including an article in the May/June issue! Spread the

word! Thanks,

> > >

> > > Re: Question of the day - DNR's

> > >

> > > (clipped)

> > >

> > > Emergency medical personnel in Texas may honor only a Texas Out-

> of-

> > > Hospital DNR form or device (bracelet or necklace) (HSC 166.102

> > ().

> > > Other health care professionals can honor other advance

> directives,

> > > including notations in charts. (History: It is worded like this

so

> > > EMS would not have to `practice law' in the two minutes they

have

> at

> > > the bedside by trying to interpret other directives.)

> > >

> > > (clipped)

> > >

> > > ---------- End of message -----------

> > >

> > >

> > > Appreciate your info! I have a question that those in the

> transfer

> > > ambulance services in this area run into frequently, and get a

> few

> > differing

> > > answers depending on who I talk to.

> > >

> > > Scenerio: An elderly patient is being transferred from the

> hospital

> > floor

> > > back to the nursing home by ambulance. The patient did not

have

> an

> > OOH-DNR

> > > in effect prior to being admitted to the hospital. However,

days

> > later her

> > > medical condition has declined to where not much else can be

done

> > for her.

> > > On transport day, while searching through her medical records

the

> > EMT finds

> > > a circled, signed, and dated physician's order stating, " DNR -

Do

> > Not

> > > Resuscitate " . There is still no OOH-DNR in her records, and

the

> > nurse

> > > confirms that these orders are the only source of information

> about

> > her code

> > > status. EMT makes a copy of this order and maintains this DNR

> > status based

> > > on it.

> > >

> > > Back when I was employed by a particular transfer service, I

was

> > informed

> > > (correctly or incorrectly) that this physician's order would be

> > acceptable

> > > for transport until the patient was placed in her bed and care

> > transferred

> > > at her destination. I could not find supporting information on

> the

> > TDSHS

> > > site about this. Thoughts?

> > >

> > > Thanks!

> > >

> > > Kim

> > >

> >

> >

> >

> >

> >

> >

> >

> >